What is the Blue Distinction Program?
Blue Distinction is a program offered by Blue Cross Blue Shield Association (BCBSA) that is used to recognize high-quality healthcare facilities and providers who demonstrate expertise in delivering quality specialty care safely, effectively and cost-efficiently. This designation is awarded by BCBSA to hospitals that apply and have proven to deliver quality results for complicated and costly procedures. Specialty procedures include knee and hip replacements, cardiac care, bariatric surgery and transplants.
Blue Distinction’s goal is to recognize and refer patients to doctors who go above and beyond and who focus on patient health and the quality of their practice, as well as spend more time on prevention, wellness and personalized care for the patients.
How does Blue Distinction work?
Blue Distinction uses selection criteria that is developed by expert physicians and medical organizations. To apply for certification, a comprehensive provider survey must be completed and uploaded via the BCBS Portal. The survey collects data on quality measures used which are patient results, treatment expertise, procedure volume and set structures and processes that support patients. These quality measures are used Nationwide at 1,600 centers across 46 states. The Blue Distinction Centers are awarded to individual facilities. If there are multiple locations, each facility will be evaluated individually based on the address.
Hip and Knee Replacement Certification Process
There are 2 levels of certification:
- Blue Distinction Centers (BDC): Healthcare providers recognized for expertise in delivering specialty care
- Blue Distinction Centers + (BCD+): Healthcare providers recognized for their expertise and cost efficiency in delivering specialty care
The Quality Metrics (BPC) portion of the survey includes readmission rates, shared decision-making practices and collection of functional patient-reported outcomes. The Cost Measure (BPC+) evaluates the cost of care episode, which starts 30 days before the date of admission and ends 90 days after discharge. An overall Composite Cost Index (CompCI) is created for each provider that is weighted by that provider’s volume and the providers’ costs. That score is rounded to the nearest 0.025. A score less than or equivalent to 1.0 is in line with the national median and values greater than 1.0 indicate more expensive providers. Of note: only providers who meet BCD are eligible to apply for BDC+. Once the provider completes the survey, it is uploaded to the web-based portal so BCBS can review and determine eligibility.
What are the benefits of Blue Distinction?
All providers and facilities that qualify under the Blue Distinction program will be advertised on BCBS websites. Patients are encouraged to choose Blue Distinction Centers as the location for their surgery because they have better outcomes, fewer complications, readmissions and higher survival rates. They even distribute patient education material to their network promoting the importance of using a Blue Distinction center. Click HERE for a sample flyer. There is a financial incentive for the patients as well, Blue Cross Blue Shield will cover costs up to 90 percent when care is received at a Blue Distinction Center, whereas other in-network providers who are not participating in the program are only covered up to 60 percent, which is a 30% variance from a patient’s perspective and a lot of money! Ultimately, the certification helps increase BCBS patient referrals.